Refugees forced to return to Syria for cancer treatment

Refugees from Syria and other middle-eastern countries are fleeing one disaster, only to face the costs of fighting another: cancer. In some cases they are even having to return home for treatment.

Cancer may not be the first thing that springs to mind when considering the challenges facing refugees, but it is a growing problem for the host countries that provide them with healthcare, says a report by the United Nations High Commissioner for Refugees (UNHCR) published this week.

In many previous conflicts, medical care for refugees has focused on curbing infectious diseases and malnutrition. However, recent waves of refuges from middle-income countries like Syria have different, and often costlier, needs.

"We are seeing many more humanitarian emergencies in middle-income countries where non-communicable diseases are more prevalent," says UNHCR chief medical expert Paul Spiegel, who led the report. "Not just cancer, but diabetes, renal disease, hypertension and hypercholesterolemia."

Although host countries can apply to the UNHCR for help with healthcare costs, a shortage of funding has caused the agency to tighten up its criteria, prioritising basic healthcare and treatment for life-threatening emergencies, and capping spending at $1000 to 2000 per person per year. Refugees with serious medical problems who need more costly treatment are referred to an exceptional care committee, which assesses their situation. "They have to make very difficult decisions about who should receive treatment," Spiegel says.

Illness or debt

When he and his colleagues assessed UNHCR applications from Iraqi and Syrian refugees living in Jordon between 2010 and 2012, they found that around a quarter were for help with cancer treatment costs. More than half of these were declined, either because the patient faced a poor prognosis or the costs of treating them were too high.

This has left many refugees living with cancer and other long-term illnesses having to forgo treatment or face crippling debts, according to a separate report issued by Amnesty International last week.

It focused on the health needs of Syrian refugees in Lebanon, many of whom rely on care subsidised by the UNHCR. Even when people are eligible for funding, recent rules mean that individuals must pay 25 per cent of the cost themselves – although there are exceptions for the very vulnerable.

"Some refugees with cancer have not received treatment since fleeing Syria; whatever money they have is spent on rent and food. In some cases, refugees have to return to Syria several times a month to receive treatment," says Sherif Elsayed-Ali, Amnesty International's head of refugees and migrants. "In such a large crisis, the international community as a whole must take responsibility for meeting the needs of refugees, but at the moment it is miserably failing."

One 43-year-old Syrian man who was declined UNHCR funding for brain cancer treatment told Amnesty: "I have no hope that the hospital will afford me radiotherapy. I am asking if they can simply afford me the medicines [to combat the dizziness]."

Given limited funding, Spiegel says that more emphasis needs to be placed on cancer prevention as well as treatment, by providing regular screening, for instance. Health insurance systems have also been implemented in other refugee settings such as Iran and Congo, with some success, he adds.

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